BETTER DATA, BETTER NETWORKS, BETTER EXPERIENCE · Title: Cari_Lee_HMA Quest Presentation...
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© Copyright 2019 Quest Analytics. All Rights Reserved. BETTER DATA, BETTER NETWORKS, BETTER EXPERIENCE Cari Lee, Vice President of Government Affairs
Transcript of BETTER DATA, BETTER NETWORKS, BETTER EXPERIENCE · Title: Cari_Lee_HMA Quest Presentation...
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© Copyright 2019 Quest Analytics. All Rights Reserved.
BETTER DATA, BETTER NETWORKS, BETTER EXPERIENCE
Cari Lee, Vice President of Government Affairs
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© Copyright 2019 Quest Analytics. All Rights Reserved. 2
Who is Quest Analytics?WE’VE BEEN THE INNOVATORS IN PROVIDER NETWORK DATA MANAGEMENT FOR 30 YEARS!
to measurenetwork access,
quantify disruption, & publish online directories
1st
Access
1st to measure,monitor, and
manage network adequacy
Adequacy
1st to measure, monitor, and
manage network accuracy
Accuracy
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© Copyright 2019 Quest Analytics. All Rights Reserved. 3
What we know.
Provider directories are woefully inaccurate
>50%30-60%MA PLANS
inaccurate
20%provider dataCHANGESANNUALLY
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© Copyright 2019 Quest Analytics. All Rights Reserved. 4
What we know.
CMS and states auditing & enforcing penalties
THREE 36 STATESFederal Programs Directory Requirements
100% MA Plansundergo audit & 47% penalized
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ADEQUACY AND ACCURACY ARE INEXTRICABLY LINKED…
Adequacy informs accuracy…
DeceasedRetiredOIG
CMS preclusion listMedicare opt-out
No longer at locationNot in network
20 addresses
16 addresses
10 addresses
6 addresses
…and accuracy
informs adequacy
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© Copyright 2019 Quest Analytics. All Rights Reserved. 6
Solving the Problem: Quest Enterprise Services
Network adequacy and accuracy in a single
platform
Network Platform
Network adequacy and accuracy across all market
segments
Enterprise
Accurate actionable data and insights integrated
within plan workflow
Workflow
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